Duration of Second Stage of Labour and Perinatal Outcome

Abstract

Background:The second stage of labour is regarded as the penultimate climax of the birth of the foetus. It has been perceived as the most critical time particularly with exposure to asphyxial insults and resultant subsequent residual damages for the foetus. To allay this anxiety and avoid untoward perinatal outcomes, it has been invoked to justify arbitrary time limits and high rates of interference to expedite the delivery as a preventative intervention. Objective:The main objective of this study is to determine perinatal outcome in relation to the duration of second stage in the Ethiopian settings in Addis Ababa.Methods: A facility-based prospective cohort study was conducted on 3776 women who delivered in the four selected teaching hospitals in Addis Ababa, Ethiopia. It focused on the outcome of the babies born to these mothers and the labour partograph data. Neonatal outcomes that were examined included the presence of meconium-stained amniotic fluid,1st minute Apgar score of <7, 5th minute Apgar score of <7, incidence of perinatal asphyxia, sepsis, foetal injury, rates of admission to the intensive care unit and perinatal mortality. Mean with standard deviation for quantitative, percentage and proportion for qualitative variables were analyzed. A confidence limit of 95% and P value of <0.05 was adopted for the expression of statistical significance. Stepwise multiple logistic regression analysis was done, and adjusted odds ratios used to explore the real association. Chi square and Fischer exact tests were also employed for categorical variables.Inclusion Criteria: term pregnancies beyond 37 completed weeks of gestation, singleton, vertex presentation, having reached or were referred either with established or prolonged second stage of labour.Exclusion Criteria: preterm deliveries before 37 completed weeks of gestation, unknown or undetermined gestational ages, intrauterine foetal death before 2nd stage of labour and neonates with known lethal congenital anomalies. Result:The mean duration of labour was 14.4 + 8.3 hours' and second stage of labour was 62 min±44 (4-330min). It was found out that perinatal complications increased with increasing duration of second stage of labour. With a duration of second stage of labour of more than 1hour, Apgar score <7, respiratory distress syndrome, meconium aspiration syndrome and admission to neonatal intensive care unit became more inevitable. Conclusion:There is increased probability of perinatal morbidity and mortality with prolonged second stage. Hence, labour should be re-assessed in order to avoid poor neonatal outcomes especially if second stage of labour is protracted beyond an hour.Recommendation: national guideline on management of labour and perinatal audit at a central higher level ought to be in place.